Liver Transplantation

A preoperative medical evaluation is critical prior to liver transplantation to determine the extent and type of the liver disease through investigations such as imaging studies, blood tests, and invasive procedures. Preoperative cardiac evaluation is used to check on the heart activity with a view of determining if the organ is fit for the major surgery while preoperative pulmonary evaluation is used to determine the condition of the lungs so that complications may be kept at a minimal. The assessment procedures include diagnosis and treatment of any current infection as a way of preventing further complications. Furthermore, the patient is briefed on the transplant surgery and aftercare as well as the necessity of taking medications.

• During recipient operations, the patient’s complete liver is extracted after removing hepatic ligaments and hilar structures.
• Encircling an IVC is required to guarantee proper blood control. There are both live and deceased donors among the sources of donors.

• Transplantation of the liver is a common type of operation. In most cases, the donor’s liver is detached on another table to prepare for transplantation.
• Thereafter, once the body of the recipient is prepared, the liver of the donor is placed on the table, and anastomosis is begun in the
• First, infrahepatic inferior vena cava is anastomosed to the portal vein.
• The next layer is the suprahepatic inferior vena cava. At the end of these phases, the clamps are released and the portal vein has to provide blood for the perfusion of the liver.
• Reconstruction of the bile duct is done after the recipient and donor’s hepatic arteries are sutured at the gastroduodenal anastomosis site.

• Conventionally, the use of living donors was restricted to children, who required liver transplant. However the demand for liver transplantation in adult patients has increased and due to lack of deceased donors mostly in developing countries the living donors are being used.
• Living donor liver transplantation is even more complex than the other types of transplantations since precise dissection is required. However, it should be noted that the graft used in the case of a living donor is not complete whereas in a deceased donor, the graft is complete.
• A graft with a hepatic vein, portal vein & hepatic artery that are relatively smaller in size is employed when a living donor transplant is being done. Incisions need to be performed on the lateral edges of the hepatic vein to allow the implantation to be carried out effectively. This ensured adequacy of materials for reconstruction of the portal, biliary and hepatic arteries.
• The Hepatic artery becomes the final site of anastomosis on the hepatic veins and it has to be long enough for the operation to occur. The next structure encountered is the Portal vein.
• The difficult feature of dissecting is due to several small tributaries of the hepatic artery. Finally, the bile duct reconstructs itself and forms a duct-to-duct anastomosis.
• This is because the left lobe contains 40% of the total volume of the liver and the left lateral sector is 20% while the right lobe is 60% in the liver graft from the live donors.
• Donors who have undergone hepatectomy are usually characterized by a single scar placed in the right subcostal area, extending to the midline.
• This approach helps to avoid dissection of the rectus muscle on both sides while performing surgery. When having right hepatic lobe transplantation, they should suture the anterior abdominal wall in relation to the left lobe before the wound is closed.

Liver Function Tests: Two markers of injury to liver cells are aspartate and alanine aminotransferases.

Alkaline Phosphatase and Gamma-Glutamyl Transferase: Indicators of bile duct function.

Total Bilirubin: Measures the amount of bilirubin in the blood.

Complete Blood Count:

WBC, RBC, and Platelet Count assess overall blood health and clotting ability.

Serology and Infectious Disease Markers:

Hepatitis B and C serology: Identifies the presence of hepatitis viruses.

Human Immunodeficiency Virus testing: Checks for HIV infection.

Cytomegalovirus testing: Identifies CMV infection.

Immunological Studies:

Human Leukocyte Antigen Typing: Ensures compatibility between donor and recipient.

Antibody Screen: Looks for antibodies that might react negatively to the organ donor.

Rejection: The transplanted liver may become rejected by the recipient immune system because the body considers it a foreign object. Despite this, rejection episodes may still occur even if immunosuppressive drugs have been administered to stop it.

Infection: As a result of immunosuppressive medications, patients are at a higher risk of infections. Bacterial, viral, and fungal infections might put the patient at risk of severe complications and may need timely intervention.

Bile duct complications: Sometimes complications involving the bile ducts may arise including strictures or leakage. These outcomes may be accompanied by additional procedures or processes to treat them.

Vascular complications: Circulatory issues like clotting or constriction could also impact blood flow to the transplanted liver.

Postoperative bleeding: Bleeding which may occur during operation, or immediately post-operation is another possible complication. It may need to be dealt with by further surgery or other means, to adequately address the bleeding.

Organ failure: Although the main reason for transplanting the liver is to replace the functioning liver, other organs can also be a problem, for example, in the form of renal failure or heart diseases.